Treatment-Free Outcomes Following Surgery for IBD: A Nationwide Cohort Study

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Clinical Epidemiology

Background:

• Inflammatory bowel disease (IBD) management often involves lifelong treatment.
• Surgery can be a curative option for select IBD patients, potentially avoiding future therapies.

Purpose of the Study:

• To identify characteristics of patients who remain treatment-free for five years post-initial IBD surgery.
• To inform precision surgery strategies for optimizing long-term patient benefit.

Main Methods:

• Nationwide cohort study using Swedish National Patient Register and ESPRESSO histopathology.
• Analysis of patients undergoing intestinal resection for Crohn's disease (CD) or total colectomy for ulcerative colitis (UC) (2007-2018).
• Calculation of adjusted odds ratios (aORs) for requiring IBD therapy within five years post-surgery.

Main Results:

• 21.5% of CD and 42.4% of UC patients remained treatment-free at five years.
• Longer preoperative disease duration in CD and older age in UC were associated with being treatment-free.
• Extraintestinal manifestations (CD aOR 0.64; UC aOR 0.48) and COPD in CD patients decreased the likelihood of remaining treatment-free.

Conclusions:

• Surgery successfully obviated further treatment in 22% of CD and 42% of UC patients.
• Absence of extraintestinal manifestations, older age (UC), longer disease duration (CD), and absence of COPD (CD) are key indicators for successful long-term surgical outcomes.
• Precision surgery can identify IBD patients most likely to benefit long-term from surgical intervention.